Preventing Concussions Using Neck Training Methods

By: Brett Bueker

Just about every kid that buckles up the shoulder pads and snaps on the helmet and chin strap, dreams of playing in the NFL someday. They dream of throwing the game winning touchdown pass to win the Super Bowl. They dream of catching the game winning touchdown pass in front of 80,000 screaming fans. They dream of kicking the game winning kick as time expires on the clock. They spend countless hours playing backyard football, drawing up plays in the dirt, wearing their favorite player’s jerseys, mimicking those game-like situations with their buddies. The days of backyard football evolves into flag football and pee-wee football leagues. The young aspiring players are continuously taught and reinforced with the proper techniques of tackling, blocking, throwing, catching, route running, and ball carrying. As they progress into the high school and collegiate level, they are taught various offensive and defensive schemes and how to gameplan against opposing offenses and defenses.

What quality makes a football player great? It may not necessarily be talent or God-given ability. Arguably, one of the most important qualities of a successful football player is his ability to think. The ability to think is the first and most important step in a successful play. One must be able to think, process that thought, react to that thought, and move kinesthetically in space to perform a successful play. If a player can do this extraordinarily well (along with having some athletic talent/size/speed), he may get a shot at achieving that childhood dream of playing in the NFL.

What part of the body enables a player to think, process, and react to perform a successful play? The brain. All of the higher cognitive processing abilities we naturally possess occur in the brain and down into the spinal column. In addition to the teaching of proper mechanics and techniques of football related movement patters, we must teach the proper methods of protecting the brain and spinal cord.  We must develop a shield of armor for physical contact. In fact, one of the most important and helpful things we can do as coaches for a player in any sort of contact sport, is off the field: neck, jaw, mandible, trap, and shoulder girdle training.

Think of the head, neck, trap, and shoulder girdle as a tree. A tree has strong roots holding the trunk and branches in place so it can withstand the physical punishments of nature. If a tree does not have strong roots and a strong trunk, the tree will break and/or collapse. Just as a tree has roots, so does the neck. The trapezius, upper back muscles, and entire shoulder girdle act as the roots to the neck, head, and brain. The neck and jaw musculature is the trunk of the tree. The head is the most important branch bearing fruit (cognitive thinking). We must have strong and stable roots (traps, upper back, shoulder girdle) to ensure we have a stable foundation. We also must have a strong trunk (neck, jaw musculature) to help absorb and the outside physical forces. Having these critical pieces will help stabilize and anchor the head and brain, hopefully decreasing the concussion/neck injury rate.

In lieu of all of the recent lawsuits presented by the NFL Players Association regarding concussions and brain damage of current and former players, neck training will most likely become a required part of each strength and conditioning program in the near future.

“Playing Football is Like Getting into 30-50 Car Accidents Within a 3-Hour Period”

-Mark Watts

According to the ImPACT (Immediate Post-Concussion Assessment and Cognitive Testing) Inc., there is an estimated 4 to 5 million reported cases of concussions each year. FOUR to FIVE MILLION. The scary fact is that number is probably even higher due to many cases of concussions going unreported each year due to lack of proper diagnosis and/or no baseline and follow up testing. ImPACT also states the prevalence of concussions in middle school age kids is on the rise as well. An NCAA study shows that football has the highest prevalence rate of concussions in all contact sports. An increase in middle school age concussion rates and football having the highest prevalence rate in all sports is a double edged sword. This is a lawsuit waiting to happen. Neck training needs to be addressed, just as the proper techniques of tackling, to these youngsters. If this paragraph has not been an eye opener to the importance of preventative measures of concussions, you need to re-evaluate your priorities.   

Here at Iowa State, we try to stay up to date with all of the newest and effective methods of training our athletes. Neck, jaw, trap, upper back, and shoulder girdle training has been a staple in our program since Coach Yancy McKnight and Coach Clayton Oyster arrived in the winter of 2009. Our number one goal as a strength staff is to help our players stay healthy so they can perform to their fullest potential out on the football field. We feel neck training has such an important role in protecting our players on the field, such that every strength and conditioning workout conducted with the football team at Iowa State targets neck training in some form or fashion. To help hammer home the importance of neck training in our strength and conditioning program under Coach McKnight, our newly constructed sports performance center is equipped with ten 5-way neck machines located in the center of our room. The 5-way neck machines are equipped with 14 different pin settings to help target all angles, working various musculature of the neck up into the head and jaw. It allows us to work neck flexion, extension, and lateral flexion. The 5-way neck machine is also equipped with handles to perform a shrug while seated on the machine. This machine alone allows us to perform 5 different (actually a lot more by changing the pin settings) methods of neck training: 1) Flexion 2) Extension 3) Lateral-right 4) Lateral-left 5) Shrug.

The Roots

There are multiple ways to train the roots of the neck, a.k.a. the traps, upper back musculature, and shoulder girdle. Any form of shoulder/scapular elevation (shrugging) will help strengthen the trapezius muscles. This can be accomplished by any variation of the following:

• BB Shrug (various grips)
• BB Overhead Shrug (various grips)
• Trap Bar Shrug
• BB Mountain Shrug (upright row to navel, shrug up, retrace shrug, retrace upright row to starting position)
• DB Shrug (with any double or single arm combination, neck extension or lateral flexion)
• Band Shrug (with any double or single arm combination, neck extension or lateral flexion)
• 5-Way Neck Machine Shrug
• DB Inverted Supported Shrug

Trap training is not just limited to shrugging exercises. Many different Olympic movements involving triple extension and shoulder/scapular elevation also produce great trap training. Some may argue that these Olympic style movements involving triple extension and shoulder/scapular elevation will in fact have a greater training effect on the traps because a much larger weight is being lifted with greater force production stimulating more motor units/pathways in the trap area. If you are pressed for time on trap training, keep your Olympic movements in your program because they are a greater “bang for your buck” exercise (involving a larger number of joints and larger muscle groups). These Olympic movements will help with force and power transfer to your specific sport due to the triple extension. The Olympic movements that require shoulder, scapular elevation include:

• Barbell Power Clean (catch or pull, from various scoop/box heights)
• Dumbbell Power Clean (seated or standing, catch or pull)
• Trap Bar Clean Pull (various scoop/box heights)
• Barbell Snatch (catch or pull, from various scoop/box heights)
• Barbell Hang Snatch
• Dumbbell Single Arm Snatch (pull or catch)
• Dumbbell Single Arm Hang Snatch (pull or catch)
• Hang Clean (catch or pull)
• Barbell Dead Lift (various grips/heights)
• Trap Bar Dead Lift (various heights)

Working down deeper into the ground is the upper back root of the neck tree. The upper back musculature is worked by any scapular retraction and/or scapular depression movement. Your muscles are continuous with the rest of your body. By strengthening the musculature of the upper back, your scapula can be set into the proper anatomical position, which will set your trapezius in the proper anatomical position, which will set your neck musculature in the proper anatomical position, which in turn helps maintain proper and safe anatomical head posture. To help set your upper back into proper anatomical positioning, be sure to balance the amount of pushing and pulling exercises throughout the week. By having too many pushing exercises, you will put yourself in position where your shoulders are rolled forward (thoracic kyphosis), putting additional, unwanted stress on the neck. If there is any imbalance throughout the week, error on the side of more pulling movements, so at least your shoulders are pulled back into the proper position. Many different exercises can be implemented to strengthen the upper back musculature:

• Band Retraction
• Mini Band Pull Apart
• Mini Band Overhead Rainbow
• Band/Rope Face Pull
• TRX High Row
• Barbell Bent Row (various grips)
• Dumbbell Bent Row
• DB Single Arm Row
• BB/TRX Inverted Row
• Pull Ups (various grips)
• Lat Pull Down
• Cable Low Row
• Landmine Single Arm Row

 

The third root of the neck tree is the shoulder girdle. It is important to maintain symmetry within the shoulder girdle to help maintain proper anatomical position. Once again, everything is connected. When doing various pressing movements such as bench press, incline press, and dips, your anterior deltoid acts as a synergist muscle group to the pectoralis (chest) to help stabilize the shoulder girdle and assist in the pressing movement. So you get lots of anterior deltoid work without even knowing it. Be sure to balance out the shoulder girdle by working the posterior deltoid, teres major, and infraspinatus. Many pulling movements will help strengthen the shoulder girdle and are better “bang for your buck” exercises. Exercises that help strengthen the shoulder girdle include:

• Band Retraction
• Mini Band Pull Apart
• Mini Band Overhead Rainbow
• Band/Rope Face Pull
• TRX High Row (+ Rotation)
• I/Y/T/A/W/L Raise (Dumbbell/TRX/Plate)
• Dumbbell Lateral Raise (Bent/Standing)
• Dumbbell Front Raise (or any variation)
• BB Bradford Press
• DB Arnold Press
• Shoulder Box
• Cuban Press
• Internal/External Rotation

The Trunk

In addition to developing strong roots, we must also develop a strong shield of armor for the trunk of our tree. A football player must be able to absorb the contact forces of repeated physical collision. We must try and strengthen the different neck musculatures to achieve this wanted stabilization of the head and brain. Mark Watts, strength coach and director of education at EliteFTS, breaks down neck musculature movements into eight different categories:

1. Flexion (head forward, chin down)
2. Extension (head backward, chin up)
3. Lateral Flexion (tilting head to side)
4. Protrusion (head & chin forward)
5. Retraction (head & chin backward)
6. Tilt (chin upward)
7. Nod (chin to chest)
8. Rotation (turning head)

 

Movements in these different planes need to be addressed and implemented into the strength and conditioning programs to help protect your athletes against concussions. Now you may not have room to program all eight of these movements into a mesocycle, so assess your athletes and pick and choose the ones you feel like to need to address. Then you can switch it up the following mesocycle. Don’t have time to complete neck training within your workout? Bad excuse. Find time. If you are in a pinch for time with the 8-hour rule, try implementing neck training into your pre-activity preparation (warm-up), pair neck with various movements within your workout as a superset, or at the end of the workout as a group as part of a “cool down”. If keeping athletes healthy and injury-free is your number one goal as a strength coach (as it should be), neck training will be a priority to you and your staff.

Whether an athlete is being introduced to neck exercises or they have been training neck for years, proper technique and time under tension during the movements will produce some of the best results. Why time under tension? First of all, increasing the time under tension during a movement slows the athletes down. They are forced to work through a full range of motion and fight through the sticking point in the strength-curve of a muscle. This allows for better technique of the movement. Time under tension also allows for greater motor unit recruitment and development in that particular area of movement. We want the extrinsic and intrinsic musculature and stabilizers of the neck to be activated. Time under tension will force the agonist, synergist, and antagonist muscle groups to act in accordance to one another. We want to increase the size, strength, and stabilization of the neck musculature to absorb the outside forces acting against the athlete. We want size, girth, and hypertrophy. An important point here: start light then progress to heavier loads as strength levels increase, and always aim for perfect technique.

Not having an adequate abundance of neck machines, or not having the budget to purchase equipment to train the neck is a poor excuse not to implement neck training. Many movements can be done with no equipment at all, or using pre-existing equipment in your facility. Various implements/methods used to train the neck include, but are not limited to:

• 4-Way Neck Machines
• Bands
• Plates
• Physioballs/Medicine Balls
• Manual Resistance
• Bridging

Now let’s take a look at various movements we can perform with each of these implements/methods.

4-Way Neck Machines

 

Flexion

                 

Start                                                                                                      Finish

• Starting position-sit up tall, spine neutral. Flex head forward, chin down to chest. Control back to starting position.

 

Extension

                   

Start                                                                                                          Finish

• Starting position-sit up tall, spine neutral. Extend head backward, chin up. Control back to starting position.

 

Lateral Flexion

                    

Start                                                                                                                Finish

• Starting position-sit up tall, spine neutral. Tilt head to side, ear to chest, shoulders as level as possible. Control back to starting position.

 

Protrusion

                                

Start                                                                                                  Finish

• Starting position-sit up tall, spine neutral. Protrude head and chin forward and straight out. Control back to starting position.

 

Retraction

                  

Start                                                                                                          Finish

• Starting position-sit up tall, spine neutral. Retract head and chin backward and straight out. Control back to starting position.

 

Bands

 

Protrusion-Option 1

                   

Start                                                                                                        Finish

• Starting position-lay on bench, shoulder blades retracted. Band on forehead. Protrude head and chin forward and straight up to ceiling. Control back to starting position.

 

Protrusion-Option 2

                   

Start                                                                                                           Finish

• Starting position-lay on bench, shoulder blades retracted. Band on forehead. Protrude head and chin forward and straight up to ceiling. Control back to starting position.

 

Retraction

                 

Start                                                                                                        Finish

• Starting position-seated on bench, shoulder blades retracted. Band underneath feet & around back of head. Extend arms straight out from shoulders. Retract head and chin backwards. Control back to starting position.

 

Extension

                   

Start                                                                                                            Finish

• Starting position-seated on bench, shoulder blades retracted. Band underneath feet & around back of head. Extend arms straight out from shoulders. Extend head backward, chin up. Control back to starting position.

 

Chin Tuck

                 

Start                                                                                                              Finish

• Starting position-seated on box or kneeling on ground. Shoulder blades retracted. Band hooked around J-hooks of squatting height or higher, shoulder blades retracted. Band underneath chin in neutral position. Nod chin down to chest. Control back to starting position.

 

Jaw Open

                 

Start                                                                                                          Finish

• Starting position-seated on box or kneeling on ground. Shoulder blades retracted. Band hooked around J-hooks of squatting height or higher, shoulder blades retracted. Band underneath chin in neutral position. Open jaw as wide as possible, keeping head neutral. Control back to starting position.

 

Plates

 

Flexion

                  

Start                                                                                                            Finish

• Starting position-laying on bench. Shoulder blades retracted. Hole of plate on forehead. Head off end of bench in neutral position. Flex head forward chin to chest. Control back to starting position.

 

Towel Extension

                 

Start                                                                                                    Finish

• Starting position-standing up tall. Shoulder blades retracted. Towel looped through plate. Bite towel. Chin to chest. Extend head backward, chin up. Control back to starting position.

 

Physioball/Medicine Ball

 

Front Flexion-Iso Hold

Start/Finish

• Starting position-feet under hips. Slight knee and hip bend. Retract shoulder blades. Place physioball/medicine ball on forehead, holding against wall. Flex head forward and chin down to chest as far as possible and hold. Ease out of position when completed.

 

Extension-Iso Hold

 

Start/Finish

• Starting position-feet under hips. Slight knee and hip bend. Retract shoulder blades. Place physioball/medicine ball on back of head, holding against wall. Extend head backward and chin up as far as possible and hold. Ease out of position when completed.

 

Lateral Flexion-Iso Hold

 

Start/Finish

• Starting position-feet under hips. Slight knee and hip bend. Retract shoulder blades. Place physioball/medicine ball just above ear on side of head, holding against wall. Tilt head to side, ear to chest as far as possible and hold. Keep shoulders level. Ease out of position when completed.

 

Manual Resistance

 

Partner Supine Field Goal

                 

Start                                                                                                         Finish

• Starting position-laying on back. Legs extended. Arms at 90° on ground in a field goal position. Retract shoulder blades. Flex head forward and chin up to chest. Partner places one hand on chest, and one hand on forehead. Both arms locked out. Resist partner’s flexion up, and apply pressure on the way back to starting position. Movement is performed in a controlled manner by both partners.

 

Partner Supine Field Goal Protrusion

               

Start                                                                                                               Finish

• Starting position-laying on back. Legs extended. Arms at 90° on ground in a field goal position. Retract shoulder blades. Protrude head and chin straight up to ceiling. Partner places one hand on chest, and one hand on forehead. Both arms locked out. Resist partner’s protrusion up, and apply pressure on the way back to starting position. Movement is performed in a controlled manner by both partners.

 

Partner Quadriped Extension

                

Start                                                                                                         Finish

• Starting position-quadriped position. Hand under shoulders (arms locked), knees under hips. Retract shoulder blades, trunk tight. Begin with chin down to chest. Extend head backward and chin up. Avoid lumber extension. Control back to starting position. Partner places on hand on upper back, and one hand on back of head. Both arms locked out. Resist partner’s extension up, and apply pressure back to starting position. Movement is performed in a controlled manner by both partners.

 

Partner Lateral Flexion Iso Hold

 

Start/Finish

• Starting position-feet under hips. Slight knee and hip bend. Retract shoulder blades. Maintain an upright and neutral position while pressure is applied. Keep shoulders level. Ease out of position when completed. Partner places hand just above ear, arm locked out. Apply as much pressure as needed to maintain proper position. Movement is performed in a controlled manner by both partners.

 

Bridging

 

Partner Forward Flexion Bridge

                   

Start                                                                                                           Finish

• Starting position-on knees with hands behind back. Retract shoulder blades. Partner will be in a bent knee, flexed hip position with hands interlocked. Place interlocked hands on forehead. Must be ready to hold up body weight of partner, so get locked in. Guy going will maintain a tight trunk and maintain neutral position as you are lowered into bridge position. Go down as far as possible. Think of flexing head forward and chin down to chest. Working angle will vary from guy to guy. Guy going place hands on ground and ease out when time is up.

 

Partner Extension Hip Bridge

                 

Start                                                                                                          Finish

• Starting position-sitting on butt, heels tight to butt. Retract shoulder blades. Partner will be in a bent knee, flexed hip position with hands interlocked. Place interlocked hands on back of head. Must be ready to hold up body weight of partner, so get locked in. Guy going will lift hips up as high as possible, driving mid-foot to heel, thinking of extending head backward and chin up to maintain a neutral position. Guy going place hands on ground and ease out when time is up.

 

Neck Bridge on Bench

                 

Start                                                                                                           Finish

• Starting position-sitting on butt, heels tight to butt. Retract shoulder blades. Place back of head on bench. Lift hips up as high as possible, driving mid-foot to heel, thinking of extending head backward and chin up to maintain a neutral position. Place hands on ground and ease out when time is up.

As you can see, many variations exist of training the trunk of our tree: the neck. There should be no excuse of not having the equipment to implement various forms on neck training into your strength and conditioning program. If your number one goal as a strength coach is to keep your athletes injury free (as it should be), training some form or fashion of the tree (shoulder girdle, upper back, traps, and neck) should be included every single training session. Explain to your athletes the importance of neck training. Get them to buy in. You are doing them a favor to help cut down the risk of getting a concussion, or even worse, sustaining a neck injury that could lead to paralysis. Do your part as a strength coach to help keep your athletes from becoming a concussion/neck related injury statistic.

Works Cited

"ImPACT Test." About ImPACT. ImPACT, n.d. Web. 28 Apr. 2014.          <https://www.impacttest.com/about/>.

ISSA. "Bodybuilding.com - Time Under Tension In Your Training Program." Bodybuilding.com   - Time Under Tension In Your Training Program. International Sports Science     Association, 23 May 2003. Web. 28 Apr. 2014.             <http://www.bodybuilding.com/fun/issa37.htm>.

"National Collegiate Athletic Association." Concussions. NCAA Sports Science Institute, 26        Dec. 2013. Web. 28 Apr. 2014. <http://ncaastudent.org/wps/wcm/connect/public/ncaa/ssi/medical%2Bconditions/concus   sion%2Blanding%2Bpage>.

Watts, Mark. "Head Games: Training the Neck to Reduce Concussions." Elite FTS. N.p., 8 Dec.   2013. Web. 28 Apr. 2014. <http://articles.elitefts.com/training-articles/sports-          training/head-games-training-the-neck-to-reduce-concussions/>.